Small bowel perforation by a piece of china with a synchronous asymptomatic sigmoid carcinoma: A case report

A 75 year old gentleman who presented with an incarcerated paraumibilical hernia was found intraoperatively to have small bowel perforation due to a piece of china with a synchronous asymptomatic sigmoid carcinoma

Geochemical assessment of metal transfer from rock and soil to water in serpentine areas of Sabah (Malaysia)

The mobility of metals in ultramafic rock–soil systems and metal contamination in serpentine soils were investigated from the Ranau area in Sabah, East Malaysia. Metal concentrations were analysed after division into seven operationally defined fractions by selective sequential extraction (SSE). Geochemical studies showed that the soils are exceptionally high in Cr (95%) residing in refractory residual fractions. Metal speciation studies will shed further light on toxicities in the Malaysian ultramafic tropical environment, reconciled against elemental metal tenure, adopted by common standards

High-dose misoprostol used in outpatient management of first trimester spontaneous abortion

Aim: The aim of this study was to evaluate the efficacy and tolerance of a high dose of vaginal misoprostol for outpatient medical management of missed abortion. Methods: Three doses of 400 μg misoprostol were administered intravaginally every 4 h daily, for a maximum period of 3 days, to 108 women with uneventful first trimester pregnancy failure. Results: A total of 98 women (90.7%) were managed successfully, with 74 (68.5%) of them within the first 24 h. The mean dose of misoprostol administered was 1,113.0 μg (range 400-3,600 μg), and the mean time required was 19.5 h (range 7-65 h). Only 6 out of 108 women (9.3%) required surgical intervention as the result of retained products of conception. The side effect profile was minimal. Conclusion: This protocol of 400 μg intravaginally misoprostol every 4 h as three daily doses for a maximum of 3 days, may offer an efficacious and safe alternative to the outpatient management of first-trimester missed abortion. © Springer-Verlag 2005

Erythropoietin in the treatment of iron deficiency anemia during pregnancy

The aim of this study was to investigate the efficacy of recombinant human erythropoietin (rHuEPO) combined with parenteral iron, in the treatment of moderate and severe iron deficiency anemia during pregnancy. Twenty-six pregnant women, who had been ineffectively treated with iron supplementation alone for at least 8 weeks, were enrolled. They met the following criteria for inclusion in the study: hemoglobin (Hb) concentration <8.5 g/dl, evidence of iron deficiency anemia, and absence of other pregnancy complications, or severe systemic diseases. The treatment protocol comprised of a combination therapy with 150 IU/kg rHuEPO subcutaneously th ree times per week a nd 100 mg parenteral iron daily, for a total period of 4 weeks. Nineteen out of 26 women (73%) showed a quick response, with Hb reaching normal levels within the first 2 weeks of treatment. They displayed an average of 3.17 g/dl increase in Hb concentration during the total period of therapy, with 3.0 g/dl increase with in th e fi rst 2 weeks. In 5 women (19.2 %) there was no significant increase in Hb levels, while in 2 women (7.6%) a further decline in Hb concentration was observed, that necessitated a blood transfusion. In conclusion, rHuEPO combined with parenteral iron is an effective treatment for moderate and severe iron deficiency anemia during pregnancy, with minimal adverse or side effects. It may serve as an alternative to blood transfusion, or in cases of resistant anemia that are not effectively treated by iron supplementation alone. However, further studies are needed to investigate the poor response observed in about 25% of treated patients. Copyright (C) 2001 S.Karger AG, Basel